Capsule Endoscopy Is Superior to Small-bowel Follow-through and Equivalent to Ileocolonoscopy in Suspected Crohn's Disease

Jonathan A Leighton, Ian M. Gralnek, Stanley A. Cohen, Ervin Toth, David R. Cave, Douglas C. Wolf, Gerard E. Mullin, Scott R. Ketover, Peter E. Legnani, Ernest G. Seidman, Michael D. Crowell, Ari J. Bergwerk, Ravit Peled, Rami Eliakim

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background & Aims: Evaluation of the small intestine for inflammation has traditionally relied on small-bowel follow-through (SBFT), but multiple studies have demonstrated its low diagnostic accuracy. Capsule endoscopy (CE) transmits high-quality images of the small intestinal mucosa; it can be used to visualize the entire length of the small bowel and much of the mucosa. We compared the diagnostic yields of CE vs SBFT in a prospective study of patients with suspected small-bowel Crohn's disease. Methods: Eighty patients with signs and/or symptoms of small-bowel Crohn's disease (age, 10-65 years) underwent CE, followed by SBFT and ileocolonoscopy. Readers were blinded to other test results. The primary outcome was the diagnostic yield for inflammatory lesions found with CE before ileocolonoscopy compared with SBFT and ileocolonoscopy. A secondary outcome was the incremental diagnostic yield of CE compared with ileocolonoscopy and CE compared with SBFT. Results: The combination of CE and ileocolonoscopy detected 107 of 110 inflammatory lesions (97.3%), whereas the combination of SBFT and ileocolonoscopy detected only 63 lesions (57.3%) (P < .001). The diagnostic yield of CE compared with ileocolonoscopy was not different (P= .09). The diagnostic yield was higher for CE than for SBFT (P < .001). Of the 80 patients with suspected Crohn's disease, 25 (31.3%) had the diagnosis confirmed. Eleven were diagnosed by CE findings alone and 5 by ileocolonoscopy findings alone. In the remaining 9 patients, diagnostic findings were identified by at least 2 of the 3 modalities. No diagnoses were made on the basis of SBFT findings alone. Conclusions: CE was better than SBFT and equivalent to ileocolonoscopy in detecting small-bowel inflammation. Although ileocolonoscopy remains the initial diagnostic test of choice, CE is safe and can establish the diagnosis of Crohn's disease in patients when ileocolonoscopy results are negative or the terminal ileum cannot be evaluated. ClinicalTrials.gov Number: NCT00487396.

Original languageEnglish (US)
Pages (from-to)609-615
Number of pages7
JournalClinical Gastroenterology and Hepatology
Volume12
Issue number4
DOIs
StatePublished - 2014

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Capsule Endoscopy
Crohn Disease
Inflammation
Intestinal Mucosa
Ileum
Routine Diagnostic Tests
Signs and Symptoms
Small Intestine
Mucous Membrane

Keywords

  • Diagnostic techniques and procedures
  • Digestive system
  • Gastrointestinal tract
  • Radiology

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Capsule Endoscopy Is Superior to Small-bowel Follow-through and Equivalent to Ileocolonoscopy in Suspected Crohn's Disease. / Leighton, Jonathan A; Gralnek, Ian M.; Cohen, Stanley A.; Toth, Ervin; Cave, David R.; Wolf, Douglas C.; Mullin, Gerard E.; Ketover, Scott R.; Legnani, Peter E.; Seidman, Ernest G.; Crowell, Michael D.; Bergwerk, Ari J.; Peled, Ravit; Eliakim, Rami.

In: Clinical Gastroenterology and Hepatology, Vol. 12, No. 4, 2014, p. 609-615.

Research output: Contribution to journalArticle

Leighton, JA, Gralnek, IM, Cohen, SA, Toth, E, Cave, DR, Wolf, DC, Mullin, GE, Ketover, SR, Legnani, PE, Seidman, EG, Crowell, MD, Bergwerk, AJ, Peled, R & Eliakim, R 2014, 'Capsule Endoscopy Is Superior to Small-bowel Follow-through and Equivalent to Ileocolonoscopy in Suspected Crohn's Disease', Clinical Gastroenterology and Hepatology, vol. 12, no. 4, pp. 609-615. https://doi.org/10.1016/j.cgh.2013.09.028
Leighton, Jonathan A ; Gralnek, Ian M. ; Cohen, Stanley A. ; Toth, Ervin ; Cave, David R. ; Wolf, Douglas C. ; Mullin, Gerard E. ; Ketover, Scott R. ; Legnani, Peter E. ; Seidman, Ernest G. ; Crowell, Michael D. ; Bergwerk, Ari J. ; Peled, Ravit ; Eliakim, Rami. / Capsule Endoscopy Is Superior to Small-bowel Follow-through and Equivalent to Ileocolonoscopy in Suspected Crohn's Disease. In: Clinical Gastroenterology and Hepatology. 2014 ; Vol. 12, No. 4. pp. 609-615.
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abstract = "Background & Aims: Evaluation of the small intestine for inflammation has traditionally relied on small-bowel follow-through (SBFT), but multiple studies have demonstrated its low diagnostic accuracy. Capsule endoscopy (CE) transmits high-quality images of the small intestinal mucosa; it can be used to visualize the entire length of the small bowel and much of the mucosa. We compared the diagnostic yields of CE vs SBFT in a prospective study of patients with suspected small-bowel Crohn's disease. Methods: Eighty patients with signs and/or symptoms of small-bowel Crohn's disease (age, 10-65 years) underwent CE, followed by SBFT and ileocolonoscopy. Readers were blinded to other test results. The primary outcome was the diagnostic yield for inflammatory lesions found with CE before ileocolonoscopy compared with SBFT and ileocolonoscopy. A secondary outcome was the incremental diagnostic yield of CE compared with ileocolonoscopy and CE compared with SBFT. Results: The combination of CE and ileocolonoscopy detected 107 of 110 inflammatory lesions (97.3{\%}), whereas the combination of SBFT and ileocolonoscopy detected only 63 lesions (57.3{\%}) (P < .001). The diagnostic yield of CE compared with ileocolonoscopy was not different (P= .09). The diagnostic yield was higher for CE than for SBFT (P < .001). Of the 80 patients with suspected Crohn's disease, 25 (31.3{\%}) had the diagnosis confirmed. Eleven were diagnosed by CE findings alone and 5 by ileocolonoscopy findings alone. In the remaining 9 patients, diagnostic findings were identified by at least 2 of the 3 modalities. No diagnoses were made on the basis of SBFT findings alone. Conclusions: CE was better than SBFT and equivalent to ileocolonoscopy in detecting small-bowel inflammation. Although ileocolonoscopy remains the initial diagnostic test of choice, CE is safe and can establish the diagnosis of Crohn's disease in patients when ileocolonoscopy results are negative or the terminal ileum cannot be evaluated. ClinicalTrials.gov Number: NCT00487396.",
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AU - Leighton, Jonathan A

AU - Gralnek, Ian M.

AU - Cohen, Stanley A.

AU - Toth, Ervin

AU - Cave, David R.

AU - Wolf, Douglas C.

AU - Mullin, Gerard E.

AU - Ketover, Scott R.

AU - Legnani, Peter E.

AU - Seidman, Ernest G.

AU - Crowell, Michael D.

AU - Bergwerk, Ari J.

AU - Peled, Ravit

AU - Eliakim, Rami

PY - 2014

Y1 - 2014

N2 - Background & Aims: Evaluation of the small intestine for inflammation has traditionally relied on small-bowel follow-through (SBFT), but multiple studies have demonstrated its low diagnostic accuracy. Capsule endoscopy (CE) transmits high-quality images of the small intestinal mucosa; it can be used to visualize the entire length of the small bowel and much of the mucosa. We compared the diagnostic yields of CE vs SBFT in a prospective study of patients with suspected small-bowel Crohn's disease. Methods: Eighty patients with signs and/or symptoms of small-bowel Crohn's disease (age, 10-65 years) underwent CE, followed by SBFT and ileocolonoscopy. Readers were blinded to other test results. The primary outcome was the diagnostic yield for inflammatory lesions found with CE before ileocolonoscopy compared with SBFT and ileocolonoscopy. A secondary outcome was the incremental diagnostic yield of CE compared with ileocolonoscopy and CE compared with SBFT. Results: The combination of CE and ileocolonoscopy detected 107 of 110 inflammatory lesions (97.3%), whereas the combination of SBFT and ileocolonoscopy detected only 63 lesions (57.3%) (P < .001). The diagnostic yield of CE compared with ileocolonoscopy was not different (P= .09). The diagnostic yield was higher for CE than for SBFT (P < .001). Of the 80 patients with suspected Crohn's disease, 25 (31.3%) had the diagnosis confirmed. Eleven were diagnosed by CE findings alone and 5 by ileocolonoscopy findings alone. In the remaining 9 patients, diagnostic findings were identified by at least 2 of the 3 modalities. No diagnoses were made on the basis of SBFT findings alone. Conclusions: CE was better than SBFT and equivalent to ileocolonoscopy in detecting small-bowel inflammation. Although ileocolonoscopy remains the initial diagnostic test of choice, CE is safe and can establish the diagnosis of Crohn's disease in patients when ileocolonoscopy results are negative or the terminal ileum cannot be evaluated. ClinicalTrials.gov Number: NCT00487396.

AB - Background & Aims: Evaluation of the small intestine for inflammation has traditionally relied on small-bowel follow-through (SBFT), but multiple studies have demonstrated its low diagnostic accuracy. Capsule endoscopy (CE) transmits high-quality images of the small intestinal mucosa; it can be used to visualize the entire length of the small bowel and much of the mucosa. We compared the diagnostic yields of CE vs SBFT in a prospective study of patients with suspected small-bowel Crohn's disease. Methods: Eighty patients with signs and/or symptoms of small-bowel Crohn's disease (age, 10-65 years) underwent CE, followed by SBFT and ileocolonoscopy. Readers were blinded to other test results. The primary outcome was the diagnostic yield for inflammatory lesions found with CE before ileocolonoscopy compared with SBFT and ileocolonoscopy. A secondary outcome was the incremental diagnostic yield of CE compared with ileocolonoscopy and CE compared with SBFT. Results: The combination of CE and ileocolonoscopy detected 107 of 110 inflammatory lesions (97.3%), whereas the combination of SBFT and ileocolonoscopy detected only 63 lesions (57.3%) (P < .001). The diagnostic yield of CE compared with ileocolonoscopy was not different (P= .09). The diagnostic yield was higher for CE than for SBFT (P < .001). Of the 80 patients with suspected Crohn's disease, 25 (31.3%) had the diagnosis confirmed. Eleven were diagnosed by CE findings alone and 5 by ileocolonoscopy findings alone. In the remaining 9 patients, diagnostic findings were identified by at least 2 of the 3 modalities. No diagnoses were made on the basis of SBFT findings alone. Conclusions: CE was better than SBFT and equivalent to ileocolonoscopy in detecting small-bowel inflammation. Although ileocolonoscopy remains the initial diagnostic test of choice, CE is safe and can establish the diagnosis of Crohn's disease in patients when ileocolonoscopy results are negative or the terminal ileum cannot be evaluated. ClinicalTrials.gov Number: NCT00487396.

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KW - Digestive system

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